osteopathic arkansas epub vol1 issue2

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AOOSTEOPATHIC ARKANSAS


The magazine of the Arkansas Osteopathic Medical Association

Volume I, Issue 2 September 2010

Passing the gavelDr. Patricia Williams inaugurated president of AOMA by Dr. Mark Baker, AOA trustee

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SOUTHERN HOSPITALITY & UNIQUE TREASURES

It’s easy to end up looking good when you choose Little Rock, a modern capital city of Southern hospitality, vibrant culture and great destinations that feel more like treasures. With a wide array of meeting facilities, accomodations and delicious dining, we’re waiting to make your next event a huge success.

The Little Rock Convention and Visitors Bureau coordinates lead distribution and responses, offers space at two convention centers, and provides convention services including destination communications, housing, registration and event coordination all under one organization—certainly a great benefit to both the meeting planners and delegates. It begins with just a phone call, and we’ll take it from there.

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This Edition

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19Letter from the Exec. DirectorE Pluribus Unum

Frazier Edwards

Dr. Tompkins Looks Back on Year as Prez

An Update on Some Pharmacological Myths

Dosha Cummins, PharmD, BCPS

D.O. the Right ThingThe Other Side of the Bars

Patricia Williams, D.O.

Cover Story AOMA Holds Annual Convention

Steve Brawner, Ed.

The Evidence-Based ApproachShane Speights, D.O.

Ask the DoctorWhat Really Causes Back Pain?

Brent Sprinkle, D.O.

Memories from IraqRandy Conover, D.O.

Interested in advertising? Great ad rates available. Call 501.374.8900 or 501.847.7743.

4 Osteopathic Arkansas

The sun was rising over the horizon as I was driving to work, and I was singing my favorite song, “One Day at a Time.” As I topped the hill into McAlaster, the silhouette of the prison greeted me.

I parked my car and walked to the gate. I was searched as usual and pre-ceded through three more sets of locked gates. From several directions I heard, “Good morning, Dr. Williams.” My nurse handed me my list of patients for the day as I entered the infirmary.

Sadness fell over me as I noted that Brickyard had died. He was found out-side the prison gate early that morning. He was 91 years old. He became a pris-oner at age 13 for stealing a horse, then a crime comparable to murder. He had finally served his time and was released. He had cried and resisted being released from the only home he had ever known.

Brickyard was loved by the guards as well as the inmates. He was jolly and had an art of turning tears into laughter for everyone with whom he came into contact. He knew no other life, he had very little education, and he could barely read and write. His spirit was gentle but spunky. His mannerisms were kind, and he always tried to be happy and bring happiness to others. Today you could feel the sadness throughout the prison.

As I allowed myself to think above my own sadness, I couldn’t help but reminisce over the life he had lived in the prison and all the stars and jewels he would find in his crown in heaven above. “Blessed is the man that endureth temptation: for when he is tried, he shall receive the crown of life, which the Lord hath promised to them that love him.” (James 1:12 NKJV) He loved his God and spoke of that love to everyone.

The prisoners were his family. All his loved ones in the outside world were gone, and no one outside of these bars even knew he existed. Being released to an outside world that he knew nothing about and having to leave the only family he knew had devastated him. Brickyard left this world wrapped in his jacket sitting by the gate just as though he had

PresidentPatricia Williams, D.O.

Family PracticeCountryside Clinic

Lake View

Past-PresidentEsther Tompkins, D.O.

PM & RArkansas Children’s Hospital

Little Rock

President-ElectRandy Conover, D.O.

Family PracticeCenterton Medical Clinic

Centerton

Secretary-TreasurerVeryl Hodges, D.O.Internal Medicine

Clopton ClinicJonesboro

TrusteesLonette Bebensee, D.O.

General SurgeryVan Buren Surgeon’s Office

Van Buren

Gary Edwards, D.O., F.A.C.O.F.P.Family PracticeCooper Clinic

Fort Smith

Roy Matthews, D.O., M.P.H.United States Air Force, Retired

Sherwood

Kenneth Seiter, D.O.AnesthesiologySparks Hospital

Ft. Smith

Shane Speights, D.O.Family PracticeUAMS - AHEC

Jonesboro

James Zini, D.O., F.A.C.O.F.PFamily Practice

Zini Medical ClinicMountain View

James Baker, D.O., F.A.C.O.I.Internal Medicine

Washington Regional Diagnostic ClinicRogers

Stacy Richardson, D.O.Intern/ResidentMountain View

Executive DirectorFrazier Edwards

Osteopathic ArkansasEditor & Publisher

Steve Brawner Steve Brawner Communications, Inc.

[email protected]

Osteopathic Arkansas is published quarterly by the Arkansas Osteopathic Medical Association. Copyright 2010 by that organization and by Steve Brawner Communications, Inc. All rights reserved.

By Patricia Williams, D.O.AOMA President

“D.O. the Right Thing”

The other side of the barsfallen asleep. He was on the other side of the bars with no more restrictions.

Everywhere I went, the prisoners were ready to share their stories about Brick-yard. Some were funny and brought laughter while others were serious and brought silence. But for me, the most awesome, thought-provoking story of all is what I call “The rest of the story.” Brickyard had only stolen back the horse that someone had stolen from him.

How his soul must have hurt and grieved at having his entire life of free-dom taken away from him. But in God’s eyes, the principles of Christianity were portrayed as he overcame the obstacles he faced. Many would have become bit-ter and resentful. He never got to experi-ence love, marriage or become a father. His dreams never got to center on having a family, building a home, or choosing a profession. There were so many things we take for granted and complain about. Instead, Brickyard became a friend and a father figure to countless inmates.

I reverently closed his chart for the final time as I prepared to go home As I left the prison, I was determined to make every day more meaningful.

Our soul is the imprint of our time on earth. It stands at the Judgment Day before God. It’s not the wealth we obtain; it’s not the things we own; it’s not the status of the charities we support, the people we know, or the position we have, that inscribes on our soul. It’s the deeds done in silence that help others and the money given in secret to relieve a burden. It’s the times we listen with our heart as well as our ears to the less fortunate and offer assurance, prayers and care that speaks to our Maker. It is at death where our soul returns to the God who created it.

As I work with patients who for one reason or other are in “bars of confine-ment,” I often think of Brickyard and how his life amplified our D.O. philoso-phy. We work with our hearts, ears, eyes, minds, and hands to extend healing through those bars when medicine is not enough.

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Dr. Esther Tompkins expects the Arkansas Osteopathic Medical Associa-tion to move in the same direction in the future that it moved while she served as president: forward.

Tompkins finished her year as presi-dent during the annual AOMA State Convention at Missouri’s Big Cedar Lodge in August.

During the past year, the AOMA’s membership climbed above 100 mem-bers, which also increased the associa-tion’s revenues.

She expects both numbers to increase under the leadership of the new presi-dent, Dr. Patty Williams, and the execu-tive director, Frazier Edwards. After all, the organization has a pretty good product to sell.

“When we try to recruit new mem-bers, we promote that this is an organi-zation that supports you, supports your rights to practice medicine in the state of Arkansas,” she said. “We work at the legislative branch, both state level and national level, to make sure that D.O.s’ rights to practice medicine are not in-fringed upon.”

As president, Tompkins participated in “D.O. Day” on Capitol Hill, where she and other advocates lobbied Arkansas’ congressional delegation for fairer Medi-care reimbursements. She found it was a fun experience. Most offices were recep-tive to their message, and all understood the differences between the osteopathic and allopathic professions.

She also represented AOMA at the American Osteopathic Association’s House of Delegates, where she witnessed the inauguration of Dr. Karen Nichols, the organization’s first female president.

It was a satisfying moment for Tomp-kins, whose entrance into the profession was anything but traditional. Not only is she a woman in what long has been a male-dominated field, but she also did not become an osteopath until she was 45 years old. She spent 10 years as

Tompkins looks back on year as prezIncrease in AOMA membership seen as one success of organization

a physical therapist before deciding to enter the profession at age 35. Ten more years of training followed before she was ready to practice medicine as a D.O.

Tompkins said that in her class, there were almost as many female students as males, and she was not the oldest stu-dent. In fact, one of her classmates was 50 years old.

Tompkins blazed a trail as the first D.O. to practice at Arkansas Children’s Hospital, where she provides pediatric

rehabilitation services. Two other osteo-paths, a radiologist and an emergency room doctor, now also serve there.

Tompkins said that there has never been a culture clash working at a hospi-tal where almost all of the other physi-cians are M.D.s.

“They treat me as equal,” she said. “They still don’t always recognize my title. They will address me as ‘Esther Tompkins, M.D.,’ and I have to always correct them: ‘No, I’m a D.O.’”

NOT EXACTLY FAREWELL REMARKS. Dr. Esther Tompkins addresses attendees at the AOMA Annual Conference. She’ll have plenty of work to do as past president.


MythsAn Update on Some Pharmacological

By Dosha Cummins, PharmD, BCPSAssociate Professor, College of PharmacyUniversity of Arkansas for Medical Sciences

Professionals at every level of prac-tice occasionally encounter myths that have been propagated for long periods of time. Some of these myths are simply old habits that should be replaced with Visit us at www.api-c.com

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more recent evidence-based approaches. Other myths may have no basis at all, but somehow they have migrated from “urban legend” to “standard of care.” It is helpful to frequently review popular

misconceptions so that practices do not become outdated.

Following are questions frequently encountered by primary care profession-als. Some represent very recent changes and new information. For the myths that have been fading for some while, evidence supporting the shift in practice has been provided.

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Patients with an acute DVT should avoid walking to prevent a pulmonary embolus.

The practice of immobilizing a patient with an acute DVT is no longer recom-mended. In fact, several studies have shown that early mobilization has actu-ally been associated with quicker resolu-tion of pain and a similar incidence of a new pulmonary embolus. This is a Grade 1A recommendation per the most recent CHEST anticoagulation guidelines. Unfortunately, the old practice is still propagated among health care profes-sionals and patients. When counseling a patient with an acute DVT, be sure to educate everyone involved in patient care. Antithrombotic and thrombolytic therapy, 8th edition: ACCP Guidelines. CHEST. 2008. 133 (6 suppl)

Glimepiride should be avoided in patients who develops a rash with Bactrim®.

Sulfonamide medications and pos-sible allergic reactions to them is a complicated topic. Although there is a minority of patients who absolutely

cannot tolerate any sulfonamide, clinical experience indicates that most patients who develop a rash with a sulfonamide antibiotic can tolerate a diuretic. A current theory is that an allergy to any of these medications does not predict cross-allergy. Structurally, sulfonamide antibiotics differ from the other classes of sulfonamide drugs in the location of the amine and sulfonyl groups. There is also more than one type of reaction that may occur (cytotoxic vs immunologic). Consequently, cross-reactivity to these drugs may be better predicted if a medi-cation with a similar structure is admin-istered. This explains why a patient who develops a rash with all sulfonamide antibiotics may tolerate a sulfonylurea or diuretic. There are populations, such as HIV-infected individuals, who have

a higher likelihood of cross-reactivity regardless of structural differences be-tween the drugs.

Remember that agents containing sulfur, sulfite, and sulfate do not cross-react with sulfonamides. Prescriber’s Letter Detail document #211114, 2005

Tetracycline should be avoided in all children less than eight years old.

Evidence that tetracyclines discolor teeth was first reported in the early 1960s, resulting in the class of antibiotics becoming contraindicated for children under eight years of age. Tetracycline binds irreversibly to calcified tooth structures if administered during the calcification process, yielding a yellow/brown/gray discoloration. It appears to stain primary teeth to a greater degree than permanent teeth. Discoloration with this antibiotic class is also seen in the adult population. Specifically, mino-cycline can cause a green/gray staining.

Keep in mind that the degree of discoloration is associated with repeated courses of therapy. Specifically, children

Sulfonylarylamines – sulfa antibiotics, aprenavir Nonsulfonylarylamines – loop diuretics, thiazides, sulfonylureas, acetazolamide Sulfonamide-containing moieties – sumat-riptan, sotalol, and topiramate

Structurally distinct sulfonamides:

Continued on next page


who receive more than five courses are at a greater risk for tooth darkening. Doxycycline, the preferred treatment for many tick-borne diseases, does not bind as strongly to calcium. It is recog-nized as acceptable treatment for Rocky Mountain spotted fever by the Ameri-can Academy of Pediatricians, and it is preferred over tetracycline. (The alterna-tive is risking fatal aplastic anemia with chloramphenicol). Kirkland KB, et al. Clin Infect Dis 1995;20:1118

Warfarin is the preferred preventive therapy for patients who have had a stroke on aspirin or clopidogrel (Plavix®).

For non-cardioembolic stroke, the current recommendations for second-ary prevention specifically state that anti-platelet agents are preferred over anti-coagulants. This recommendation is cited as Class 1, Level A in the 2006 stroke guidelines and Grade 1A in the 2008 CHEST guidelines. Additionally, no single agent or combination has been well studied in patients who have had an event while receiving aspirin. We all see patients without atrial fibrillation who have been placed on warfarin to prevent another stroke. Despite this practice, there is no evidence that warfarin is more effective for these patients than aspirin, Aggrenox® or Plavix®. Ad-ditionally, aspirin plus Plavix® is NOT recommended in these patients due to the risk of bleeding. Antithrombotic and thrombolytic therapy, 8th edition: ACCP Guidelines. CHEST. 2008. 133 (6 suppl); Prevention of Stroke in Patients with Stroke or TIA, American Heart Associa-tion/American Stroke Association. Stroke 2006:37:577

A woman on OCPs does not need to use condoms or abstain from sex for any time period unless she has missed 3 or more active pills.

A variety of OCPs are now available, including formulations with very low doses of estrogen. As newer products have been approved, many women have changed from one type of OCP to anoth-er.

The low doses of estrogen in some OCPs (20 ug) make it imperative that women use them correctly, as missed

doses of these newer pills may be associ-ated with a higher incidence of preg-nancy. The World Health Organization recently updated their guidelines and ad-dressed missed OCPs. Women on 20ug pills should use additional contraception for seven days if they miss two or more pills or start a pack two days late. Users of the 30-35ug pills are not advised to do this until they have missed three doses or started a pack three days late. Selected Practice Recommendations for Contra-ceptive Use, Department of Reproductive Health and Research, Family and Com-munity Health, WHO, Geneva, 2004, Second Edition, 2004; http://www.searo.who.int/LinkFiles/Publications_spr.pdf

Avoid metformin in patients with CHF.Early evidence suggested that CHF is

a risk factor for lactic acidosis in metfor-min users, and it was subsequently listed as a contraindication in the package insert.

Recent retrospective data from more than 16,000 study participants indicate that metformin may be safe in some CHF patients. The Food and Drug Administration removed the contraindi-cation in 2005, and the current package label (revised in 2006) now includes CHF in the warning section.

The stability of the patient is a key consideration if metformin is to be used. Unstable patients or those at risk of hypoperfusion and hypoxemia remain at risk for lactic acidosis. Patients who are on the medication and have an acute ex-acerbation should have the drug tempo-rarily discontinued. Stable patients who benefit from metformin and are closely monitored may safely remain on the

drug. Glucophage (metformin) prescrib-ing information. Bristol-Myers Squibb, Princeton, NJ. June 2006; Roberts F, Ryan GJ. The safety of metformin in heart fail-ure. Ann Pharmacother 2007;41:642-6.

Patients with mitral valve prolapse need antibiotics prior to dental visits to prevent bacterial endocarditis.

Nearly a decade passed before the American Heart Association revised their guidelines for the prevention of bacterial infective endocarditis (IE) in 2007. The advising committee highlight-ed some major changes in their updated document. The new recommendations acknowledge that only a very small number of cases of bacterial IE would actually be prevented with antibiotic prophylaxis, even if there were a 100 percent efficacy rate. In fact, IE is more likely due to frequent exposure from daily activities (such as flossing teeth).

The table above summarizes the current recommendations. A single dose of amoxicillin (2g), clindamycin (600mg) and azithromycin (500mg) are all options for prophylaxis if taken 30-60 minutes before the procedure. Post-procedure dosing was dropped as a recommendation in 1998. Prevention of Infective Endocarditis: Guidelines from the American Heart Association http://circ.ahajournals.org/cgi/content/full/cir-culationaha;116/15/e376;

The author is associate professor at the University of Arkansas for Medical Sciences College of Pharmacy and assistant professor at the Department of Family and Community Medicine at the Area Health Education Cen-ter – Northeast.

Artificial heart valveHistory of infective endocarditisCardiac transplantCertain congenital heart conditions • Un-repaired/incompletely repaired cyanotic condition • Completely repaired defect with prosthetic material device (for 6 months following the procedure) • Any repaired defect with residual defect at the site or adjacent to the site of a prosthetic patch or device

Need prophylaxis*

Mitral valve prolapseRheumatic heart diseaseBicuspid valve diseaseCalcified aortic diseaseVentral septal defect, atrial septal defect, and hypertro-phic cardiomegaly

No longer need prophylaxis

Antibiotic Prophylaxis Recommendations Prior to Dental Procedures

* Note that GI procedures, GU procedures, and cardiac stents do not require prophylaxis

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Letter from the Executive Director

Frazier Edwards

E Pluribus UnumIt can be interesting meeting with

potential partners, certain association executives, and even some physicians. Over the phone, they, like any nor-mal person, build a mental image of whom they are setting up a meeting with. Then, the moment that I open my office door and offer my hand in welcome, I see the wheels in their head turning. They are distracted from whatever talking points they had as they try to find the answer to the burning question, “How old are you?” Eventually they just ask. That is always followed by, “How did you get this job?” or, if they have more tact, “What did you do before this job?” I have grown accustomed to these questions and am more than happy to answer them.

It can be frustrating, at times, to be judged by my outward appearance before I can open my mouth in order to open their mind. However, I have never had a problem with proving myself. I understand the hesitation some might have about having a pro-fessional relationship with someone who has the facial composition of an infant. Therefore, I must work 10 times harder in order gain the knowledge they obtained in years of their trade in order to overcome their preconceived notions.

The fact of the matter is that I love the challenge. I love when people tell me I can’t do something because of some figure or statistic. It makes me want to work that much harder to prove them wrong.

I say all of this to bring up a ques-tion that has always intrigued me. What makes a great leader or, more broadly, what is leadership? Does it require age and experience? Is it some

innate ability that few possess? How does one even begin to define the term “leader”? This often can be a sensitive subject to discuss, especially with those who hold positions of influence and have differing viewpoints.

Disclaimer: I am not speaking about any particular person or group, only in generalities.

A true leader wants no power except the ability to give power. This influ-ences and empowers others to reach goals set forth by the collective group. However, here lies the major conflict with today’s leaders: “Absolute power corrupts absolutely.” Those who have it aren’t likely to give it up. Promises can be made about serving others, but find-ing truth in their dealings usually leads away from the greater good and more towards narcissism.

If the previous is true, then a great leader can only be as good as the collective. This thought suggests that leadership is not a singular notion and that a movement or cause is only limited by the ethics of the collective. Giving members of the collective the ability to advance and adapt as neces-sary ensures growth and sustainabil-ity. It also removes barriers for those seeking involvement. Imagine remov-ing the idea of “working the system” in order to participate and contribute. When you are the system, you have two choices: Action or Abstinence.

Often times we are under the illu-sion that one must shoulder the burden and show the way at all times. This is hardly ever the case. What we seldom see is the support system built around figureheads, and we become blind to the guiding force of a foundation that carries them through the tough times and decisions. The foundation only

reinforces the argument that leadership is not a singular term, and it needs to be unselfish in nature.

However, this theory does not exclude the action of one standing out or standing up to do what is right for the collective. Sometimes it is necessary to influence a revival within the group. The noble action of one, without the declaration and a follow-through by many, is that of a lone martyr.

So how do age, experience, and all of those other qualities that define a person as a leader influence the collec-tive? To answer that question, you must first listen. You have to allow yourself to hear what is being said without bias. If you do that, you can see where some-one’s priorities lie, and from there you can make your own assumptions.

It’s easy for people to ask for mercy in easier circumstances. God prom-ised us that He wouldn’t give us a task that we couldn’t handle. Therefore, we should pray for strength and wisdom to handle whatever life throws at us.

I can think of no greater time to ask for those things than the current and future physician environment. There is no greater time to stand together than now, and the association is a collective voice that will not be silenced.

In retrospect, it has been an easy choice to prove my intentions and defend my position because I have great people providing me with a sturdy foundation. It’s easy to work hard for people who believe in you as much as you believe in them. I will always stand up for our physicians, and I will always fight for our organization. I’m glad that physicians are on the front line for to-day’s issues. Is there anyone more quali-fied to fight for what is right? I don’t think so. Stand up with us and lead.


The beautiful setting of Missouri’s Table Rock Lake and the rustic pleasures of Big Cedar Lodge welcomed members of the Arkansas Osteopathic Medical Association for the 25th annual AOMA State Convention August 11-15.

The event drew several national leaders, including Karen Nichols, D.O., president of the American Osteopathic Association, and Keith Studdard, AOA director of congressional affairs. The AOMA’s own Kenneth Heiles, D.O., president of the American College of Osteopathic Family Physicians, ad-dressed the group Aug. 13, while Mark Baker, D.O., an AOA trustee, spoke Aug. 14. Heidi Couch, president of the Advocates of the American Osteopathic

AOMA holds annual conventionBeautiful surroundings draw big crowd to silver anniversary conventionBy Steve BrawnerEditor

Association, a group made up primarily of osteopaths’ spouses and significant others, discussed her group’s role and invited members to attend the AOA’s Osteopathic Medical Conference & Exposition, which will be in San Fran-cisco Oct. 24-28. Her group is sponsor-ing a program by former University of Arkansas athletic director Frank Broyles and his family about dealing with a fam-ily member with Alzheimer’s disease. Dr. Trent Pierce, chairman of the Arkansas State Medical Board, updated attendees on recent actions by the board.

The AOMA typically has hosted its annual convention in Eureka Springs, but Past President Esther Tompkins, D.O., said the leadership decided the members were ready for a change the past two years. Last year’s was in Rogers.

The highlight was the annual awards banquet, where Baker administered the oath of office to the AOMA’s new presi-dent, Lakeview’s Patty Williams, D.O.; to the president-elect, Randy Conover,

D.O., of Centerton; to the secretary/trea-surer, Veryl Hodges, D.O., of Jonesboro; and to the newest trustee, James Baker, D.O., of Bentonville.

Award winners were:– Kenneth Heiles, D.O., received the

George Bean, D.O., Memorial Outstand-ing Physician Award.

– Pat Bell, D.O., creator of the Arkan-sas Wild Wings Association, an out-doors-related organization that benefits the American Cancer Society’s Relay for Life, received the Humanitarian Award.

– Chad Carter, D.O., was presented the James E. Zini Young Physician Award by Roy Matthews, D.O., who had hand-carved a staff in celebration of the occasion. Carter, now a military physi-cian, said he had become an osteopath thanks to the influence of the AOMA.

– Sherry Robinson and Innovative Spine Care received an Award of Appre-ciation.

– Tompkins was presented a Presi-dent’s Plaque in recognition of her ser-

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vice, prompting her to make this short and lighthearted farewell speech. “Thank you, once again. It’s been my pleasure to serve. And that’s my brief comments.”

During his address, Heiles told at-tendees that the ACOFP had supported health care reform efforts with reserva-

tions, explaining later in an interview that the college was following the lead of the American Osteopathic Association. Heiles said that his group was disap-pointed that reforms did not better ad-dress Medicare reimbursement shortfalls and did not address tort reform at all.

However, the ACOFP did support the effort’s attempt to provide insurance coverage to more Americans.

“We support the concept of health care reform,” he said. “We supported the bill that was out there for the main purpose of getting something rolling. We did not support all parts of the bill.”

Heiles also warned attendees that a shortage of residencies looms. In fact, he said, by 2017 there will be 3,000 more osteopathic graduates than training sites, a problem also faced by allopathic practitioners.

Dr. Mark Baker updated attendees on progress the AOA has been making on revising its strategic plan. He said board members and invited guests recently had developed goals and objectives and that Dr. Nichols would be meeting with leaders of state associations in order to obtain their buy-in. He encouraged attendees to contact their senators and representatives about raising Medicare reimbursement rates by calling the AOA legislative hotline at (877) 262-9400. The AOA’s website also has templates members can use for contacting repre-sentatives.

Baker also encouraged attendees to help new osteopaths gain their footing, saying, “Each one of us has a great deal of experience and knowledge that we can share and that would help advance our whole profession, so I encourage each of you to be a mentor.”

Mentorship was a theme of a special Lifetime Friend of the AOMA Award presented by Jim Zini, D.O., to the Okla-homa Osteopathic Association, which served as a “big brother” for the AOMA as it was formed during its early years. The OOA’s president-elect, LeRoy Young, D.O., and executive director, Lynette Mc-Clain, accepted the award. Zini recalled how the association had shepherded the AOMA through its early years.

“We loved the way they did their meetings,” Zini said. “There was cama-raderie. There was family. There was genuine caring about each other. And they adopted us as if we belonged to them, as if we were part of their family. Because of that, we wanted to pattern our association after theirs and do things the way they did them, and they helped us do that.”

ALL IN ONE PLACE. Attendees of the AOMA Convention pose for a group photo at Big Cedar Lodge, top. Above, Chad Carter, D.O., right, recipient of the James E. Zini Young Physician Award, admires a staff hand-carved by Roy Matthews, D.O., left. Jim Zini, D.O., looks on.


OATHS AND AWARDS. Top left, Mark Baker, D.O., left, administers the oath of office to James Baker, D.O., the AOMA’s newest trustee. Top right, Dr. Baker administers the oath to Veryl Hodges, D.O., the new secretary-trea-surer. Middle left, Dr. Esther Tompkins, past president, displays awards given to her in recognition of her service. With her are Randy Conover, D.O., president-elect, left, and Frazier Ed-wards, executive director. Middle right, Pat Bell, D.O., founder of the Arkansas Wild Wings Association benefiting the American Cancer Society’s Relay for Life, received the Humanitarian Award. Left, Dr. Conover presents the Life-time Friend of the AOMA Award to the Oklahoma Osteopathic Association, which served as a “big brother” for the AOMA during its formative years. OOA’s president-elect, LeRoy Young, D.O., and executive director, Lynette McClain, accept the award.

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AROUND THE CONFERENCE. Top left, James Baker, D.O., left, and Stuart Benson, D.O., applaud remarks at the annual conference. Top right, Rhonda Higgins, D.O., listens to one of the pre-sentations. Middle left, James Cooper, D.O., gives a presentation August 14. Center, Bob Sanders, D.O., shows off a flat screen TV won during the raffle. Middle right, Carolyn Dillard, D.O., sets aside a door prize she won during the drawing. Bottom right, Bill Lagaly, D.O., right, chats with Dr. Mark Baker.


GOLF OUTING. Above, Dr. Tompkins reacts to a missed putt during the golf scramble at the Holiday Hills Resort and Golf Club. Top left, Gary Edwards, D.O., gets ready to hit a drive. Middle left, Thomas Wood, D.O., follows through on a drive while Dr. Conover looks on. Bottom left, Dewey McAfee, D.O., prepares to hit a drive.

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MORE FROM THE CONFERENCE. Top left, Brent Sprinkle, D.O., hits a drive during the golf scramble. Top right, Kenneth Heiles, D.O., of Star City, president of the American College of Osteopathic Family Physicians, describes some of the issues facing the profession. Middle left, Kenneth Chan, D.O., a neurologist from Jones-boro, leads a session on diagnosing and treating epilepsy in the primary setting. Middle right, Dr. Lagaly, Dr. Carter, and Dr. Wood accept golf awards. Bottom right, Sam Moore, D.O., laughs for receiving an “award” for having the highest golf score along with his partner, Frazier Edwards. Moore is pictured with his son, Lucas.


What would you do in a disaster?Some of you may have thought about

this question prior to the tornadoes, hurricanes, ice storms, recent floods and pandemic influenza that have affected our state in one form or fashion over the recent months and years. My guess is that more of you think about it now.

The obvious answer is, “It depends.” It depends on where you live, where you practice, and what you practice. What are your commitments to your patients, your family, and your medical commu-nity?

As community physicians, we are seen as the medical leaders in our com-munities and are often called upon to lend our expertise and advice in han-dling large-scale medical needs.

The good news is that there are excellent courses available to better

prepare you for the next disaster. These physician-level courses take you from a basic understanding and education of personal disaster preparedness to the level of being an incident commander at a major catastrophe.

The Basic Disaster Life Support (7.5-hr CME), and Advanced Disaster Life Support (15.5-hr CME) courses were established by the National Disaster Life Support Foundation in an attempt to better educate physicians and health care providers on a unified approach to managing a disaster. I have had the op-portunity to participate in these courses and highly recommend them.

Currently, they are offered twice a year on the Arkansas State University main campus in Jonesboro. Anyone that is interested can contact Dr. Deborah Persell at (870) 972-3318 or [email protected].

Reference: http://www.ndlsf.org/

Heat-related IllnessesIt’s always a good idea during warm

weather to advise your patients to be mindful of their exposure to the heat. Elderly patients, those on medications that increase their risk of heat-related illnesses, those working outdoors, and

By Shane Speights, D.O.Assistant Professor of MedicineUniversity of Arkansas for Medical Sciences, AHEC-NE

“The

vidence-based Approach”EA compilation of evidence-based guidelines for the primary care physician.

especially those weekend gardeners who may not be acclimated to the heat are particularly susceptible to heat-related illnesses.

The spectrum of heat-related illnesses varies from heat exhaustion involving such symptoms as nausea, weakness, dizziness, and headache to the critical and sometimes fatal heat stroke where renal, neurologic, and cardiovascular collapse can occur.

Most of these conditions occur due to a disregard of symptoms and poor hydration over a period of several days that lead to the body’s inability to com-pensate and transfer heat. Generally, for most patients the current literature re-veals that water is the fluid of choice for hydration when compared to products such as Gatorade® or Powerade®. Howev-er, the studies also show that since they taste better than water, patients are more apt to drink those products regularly.

The bottom line is that if you have normal kidney function, water is the answer for staying hydrated. Also, make sure your patients aren’t still using those salt tablets from their high school football days. Those can lead to hyperna-tremic dehydration.

Reference: Auerbach, Wilderness Medi-cine 5th ed, pp 228-283, copyright 2007.

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SPF (Sun Protection Factor) Refresher

The effectiveness of sunscreen is based on two elements: 1) SPF rating and 2) skin type (1-6). The SPF rating is really a measure of how long the sun-screen will protect you based on your skin type. A common misconception is that a 60 SPF sun block will provide twice the protection of the SPF 30 from the harmful UVA and UVB rays. The reality is that the actual protection provided is almost equal (SPF 30=96.7%, SPF 60=98.0%).

Your skin type really determines which SPF is needed. A fair-skinned fel-low like me (type 2) needs a SPF of 60 to get about 4-5 hours of protection. On the contrary, my olive-skinned brother who tans well and rarely burns (type 4) can get the same protection from a SPF 15 sun block. Both of us still have to reapply after 4 to 5 hours for continued protec-tion. Don’t forget the UVA/UVB protec-tive eyewear as well.

Reference: Auerbach, Wilderness Medi-cine 5th ed, pp 362-363, copyright 2007.

Sea sponges as metastatic breast cancer treatment

My mother, a conservative naturalist, always thought that the cures for many of our worst diseases and ailments could be found in nature.

Here’s another example that Mother probably does know best (though we still hate to admit it). Eribulin is a chemo-therapy drug derived from sea sponge that targets cell division.

The Phase III EMBRACE study was an open-label, randomized, multi-cen-

tered study of 762 patients with meta-static breast cancer or locally recurrent breast cancer who were treated with at least two and a maximum of five prior chemotherapies. The primary endpoint, overall survival, was 2.5 months longer in the “sea sponge” treated group than in patients who received physician choice treatments. Obviously not the magic bullet we’ve been looking for in the treatment of breast cancer, but promis-ing still.

Reference: Pharmaceutical Business Review; June 7, 2010.

cadmium had a higher rate of absorption over adults.

Reference: http://www.atsdr.cdc.gov/toxprofiles/phs5.html#bookmark06

Type 1 - Very Fair SkinNever Tans I Always Burns

Slowly Tans I Burns Easily

Gradually Tans I Initially Burns

Tans Well I Minimal Burns

Easily Tans I Rarely Burns

1 Hour

Type 2 - Fair Skin

Type 3 - Light Skin

Type 4 - Medium Skin

Type 5,6 - Dark Skin

2 Hours 3 Hours 4 Hours 5 Hours

SPF

15SPF

15SPF

15SPF

15SPF

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30

SPF

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60SPF

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SPF

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60SPF

30SPF

30SPF

8SPF

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Another glass of cadmium, pleaseYou may remember the McDonald’s

recall that occurred earlier this summer over the Shrek Forever After kids glasses. The problem was with the level of cad-mium that was used in the paint during the manufacture of the glasses. There was also a previous recall of cadmium-containing children’s jewelry by Wal-Mart.

Cadmium is a naturally occurring element found in certain foods such as shellfish, organ meats, leafy vegetables and grains, as well as in industrial en-vironments, batteries, cigarettes, and a host of other products.

The level of cadmium in the glasses varied, but tests revealed levels from 670 to 956 parts per million, which is higher than the federal level of 75 parts per million.

Cadmium can damage the liver, kidneys, bones, and lungs depending on the route of entry into the body. The EPA has ranked it as a carcinogen. In some studies, younger animals exposed to

Proton pump inhibitors and fracture risk

This has been a hot topic for several years when in 2006 the Journal of the American Medical Association produced an article on the possible link between PPI use and increased risk of hip frac-ture.

Since that time there have been several other studies and papers writ-ten on this subject. Recently, an article was published in the May 10th issue of Archives of Internal Medicine looking at female patients taking PPIs that were involved in the Women’s Health Initia-tive. Specifically, they looked at PPI use and fracture risk.

Their conclusion was that long-term PPI use did not significantly increase hip fractures, which carry a higher morbid-ity and mortality than most other frac-tures. However, there was a significant increase in PPI users and wrist/forearm fracture (OR 1.3), spine fracture (OR 1.5), and overall fractures (OR 1.3).

Oddly, bone mineral density levels between the groups were not statistically significant. The theory is that the proton pump inhibitors suppress stomach acid and cause a decrease in the absorption of calcium, which in turn decreases bone density.

There seems to be more and more information coming out about the long-term negatives of PPI use. I think the take home message is to re-evaluate your patients that are on chronic PPI therapy to see if they really need it. Perhaps some of those patients would do just as well with a traditional H2 blocker.

References: http://www.ncbi.nlm.nih.gov/pubmed/20458083?dopt=Abstract; http://www.ncbi.nlm.nih.gov/pubmed/17190895?dopt=Abstract


What causes back pain? The answer to that question depends, in large part, on who you are asking. If you were to ask a psychologist, he or she might say that all back pain stems from deep psychological conflicts or problems with self esteem, financial troubles or job dissatisfaction. An acupuncturist might believe it is an imbalance of the meridian energies throughout your body. A chiroprac-tor would say it might be that you have various subluxations in your spine, and those need to be corrected. A physical therapist would say that you lack flexibil-ity in your hamstring muscles, and you lack core strength in your abdominal and lower back muscles. A pharmacist would say, “Just take this ibuprofen and you’ll be fine.”

As you can see, back pain is a com-mon human ailment, and there is a wide spectrum of health care providers who have their own perceptions of what may be its root cause.

Navigating this arena of opinions and perspectives can be very challenging for a patient. In truth, I don’t think any of the previously mentioned health care providers are exactly right or exactly wrong.

This is where I come in. Being a physician specialist in physical medicine and rehabilitation uniquely prepares me to consider and manage the expertise of other health care providers for diagno-sis and treatment. The cornerstone for answering the question of what really causes back pain is the process of that

By W. Brent Sprinkle, D.O.Arkansas Specialty Orthopaedics

“Ask the Doctor”

What really causes back pain?

discovery. That process should begin with obtaining the most accurate and most specific diagnosis possible.

First comes a good understanding of the history of pain complaints and a good physical examination, often times narrowing down the most likely con-tributors. Next, contributory testing such as EMG and electro-diagnostic studies in the case of a possible nerve impingement may be used. Often, x-rays and MRIs are utilized.

It’s important to consider where these diagnostics are performed so that you may obtain studies of the highest quality that are of the greatest value in lead-ing to an accurate diagnosis. It is very important that the diagnostic compo-

nent of determining the cause of back pain is acquired by a physician, and the diagnostic studies are also performed by a physician, especially the EMG compo-nent. There are automated devices and non-physician providers who attempt to perform these studies. Unfortunately, often these are not of good quality and are not diagnostically accurate enough to make the best decision for the care of the patient.

Another area of challenge is in diag-nostic image quality, especially concern-ing an MRI. Technology has improved considerably in the last five to 10 years. Unfortunately, some of the older tech-nology is still being used in the rural areas of Arkansas. Trying to make medi-cal decisions based on poor-quality MRI scans is very difficult. I sometimes ask my patients if they would rather have a picture of their back taken with a five- or six-year-old one-megapixel digital cam-era or with the latest model 10-mega-pixel high-resolution digital camera. To me, having the high-megapixel image greatly improves the chances of making the most accurate diagnosis possible.

The range of possible causes of back pain is broad. Some of the most com-mon causes are related to strain or injury, excessive tightness of muscles, problems with the discs, problems with arthritis, misalignment of the vertebrae, infection, tumors, fractures or disc de-generation. In a later series, hopefully we can consider some of the more common causes in greater detail.

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As my flight to Iraq began, I felt a combination of fear of the unknown and gratitude to be of service to others as a battalion surgeon.

I contemplated my desires for my family if I did not return home alive and my reasons for serving as a physician in the military. I wanted my wife, Michelle, and my five children left in Arkansas to know I loved them and to understand why certain things were important to me, specifically faith in God and kind-ness to others.

As a young man in the Boy Scouts of America, I often had raised my hand and repeated the Scout Oath: “On my honor, I will do my best to do my duty to God and my country and to obey the Scout Law: To help other people at all times, to keep myself physically strong, mentally awake and morally straight.”

Choosing my profession as an os-teopathic family physician has offered me the opportunities to do just that. I have been able to help others, young and old, physically and mentally through medicine, counseling and osteopathic treatments in hospitals, clinics and in pa-tients’ homes. Serving in the Army gave me the opportunity to do my duty to country while helping the soldiers of not only the U.S. armed forces but also allied soldiers and citizens of other countries.

An experience that occurred a couple of days prior to my leaving Iraq was very dear to me. I was to leave for the U.S. one week prior, but my paperwork was de-layed, which meant I stayed long enough to meet Nataif, a young Iraqi girl. I was grateful for that opportunity.

We did not meet under the best of circumstances. I was called out to the front of our compound and briefed on the situation. A three-year-old Iraqi girl

Memories from IraqPresident Obama announced in late August that U.S. combat opera-tions have ended in Iraq, though thousands of American troops will remain. One Arkansas osteopath recalls his service there in 2004.

By Randy Conover, D.O.

had been in a burn accident and had been taken from one hospital/clinic to another, but in Iraq the clinics were far apart and all closed since it was their sabbath day. When I arrived at the scene, some officers were trying to obtain a helicopter, some medics were preparing the ambulance, and a group of four to five medics was placing oxygen over her mouth and monitoring her vital signs to ensure she still had a pulse. They were trying to get IV access to resuscitate her but were having little success because her veins were collapsing from dehydration.

I could see she was a beautiful girl in spite of the burns that covered half of her body. With my own two-year-old only daughter at home, I had additional fatherly instincts that wanted to help in any way I could.

She wasn’t responding to our voices or the needles that were entering her arm. Not having access to a standard U.S. hospital kit for inserting an IV into her leg bone, I asked for a large needle and

hand-drilled it into her lower leg. She never flinched, reconfirming how close to death she really was, probably within the hour. The IV access through her bone provided enough fluid to get her to a hospital, where she soon responded to the doctors, nurses and soldiers. She later was transferred to Germany for plastic surgery and had a full recovery.

As it turned out, I returned safely home and only had a couple of close calls during my stay in Iraq. I met some of the bravest and most honorable men and women I have ever known and was honored to serve among them.

This year as we celebrate the various patriotic holidays, let us remember the heroes who didn’t make it home. Let us remember the families who sacrifice as much and sometimes more as they wait alone here at home. Let us honor all those who sacrifice themselves for our protection and the freedom of our neighbors overseas. To all the other phy-sicians who serve, thank you.

OFF TO WAR, COMING HOME. Top, Dr. Randy Conover is pictured with his family on May 18, 2004. Pictured are, from left, wife Michelle and children Jaclyn, J.T., Jordan, Jared and Jay. Inset, Conover, right, is pictured at Camp Bucca in Iraq on Feb. 26, 2004.

PRSRT STDU.S. POSTAGE

PAIDLITTLE ROCK, ARPERMIT NO. 2437

Tuesday, October 26

11 AM - 12 PM

San FranciscoMarriott Marquis

Advocates for the AmericanOsteopathic Association —supportingand promoting the osteopathicprofession through communityoutreach, membership-drivenactivities, project grants, scholarships,and more.

“Three Generations of Alzheimer’s”With Coach Frank Broyles

The Advocates for the American Osteopathic Association (AAOA) areproud to present OMED 2010 guest speaker Coach Frank Broylesand family. Together with his daughter and granddaughter, CoachBroyles will share his three-generational approach to coping withAlzheimer’s Disease.

After 50 years with the University of Arkansas Razorback AthleticsDepartment, Coach Broyles retired to care for his wife while shesuffered from Alzheimer’s Disease. His practical guide, “Playbook forAlzheimer’s Caregivers,” gives real-life advice to caring for anindividual suffering from this disease.

Please join the AAOA for this special presentation!

Learn more at www.alzheimersplaybook.com.

AAOA 142 Phone: 312.202.8190 Email: [email protected] WWW.ADVOCATES4DOS.ORG

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